The Gun-Suicide Myth

What are the facts regarding suicide and guns? Is a completed suicide more likely if a gun is in the house or available? If you are pro gun-control you would site a US statistic like: 5.6% of suicide attempts are by gun, but 55% of successful suicides are by firearms. You would conclude that easy access to a gun increases the chances tenfold that a suicide attempt will be fatal.

Seems fairly straight forward. That is, until you look at other countries with strict gun control laws.

Japan holds some of the most rigid and inflexible gun control laws in the democratic world. Sportsmen are allowed shotguns only, for hunting and skeet shooting -- period. These sportsmen can only obtain permission to buy a firearm after a lengthy bureaucratic screening that includes: Classes, interviews, written exams, shooting tests, background check, drug testing and a psychological evaluation to asses for mental illness.

They even check the applicants' relatives for criminal activity and mental illness. If a Japanese citizen does not pass this rigorous screening, he cannot own a gun. And, without the government's permission, it’s against the law for a Japanese citizen to even HOLD a gun.

With such strict laws limiting firearm access, if guns were primarily responsible for successful suicides, then logic would dictate that Japan would have one of the lowest suicide rates in the world. Right? Wrong. Japan has averaged over 30,000 suicides annually for the past 14 years. That’s almost 24 suicides per 100,000 people. In America the rate is 12 per 100,000 people, half that of Japan.

Statistically most completed suicides in the US are indeed by firearms, simply because they're lethal and readily available. But if they were not, someone who was determined to end his life would find a way to do it, à la Japan.

There are many ways to attempt suicide with varying degrees of success. I’ve found the potential lethality of the attempt is directly related to how serious the individual is about ending their life. I’ve seen patients that have scratched their wrist a few times with a dull knife-- barely breaking the skin, who end up in the ER and say they were trying to kill themselves. Others will take 15 Advil, call their ex-boyfriend and say they just over-dosed in a suicide attempt and then wait for rescue. We call those ‘suicide gestures’. The person had no intent to die. Rather, it was attention seeking behavior.

On the other hand, as I discuss in my last blog, there are people like Mindy McCready, who have made the decision to end it and don’t tell a soul about what they plan to do. They choose a lethal method; be it by gun, hanging, jumping, leaping or poison gas…. and then they do it.

Suicide is often preventable with early recognition, proper mental health treatment and a strong support system. But we are kidding ourselves to think that removing access to a gun will make any difference to the suicide rate in the US. I wish it were that easy.

The comparison between the US and Japan's suicide rates based on different gun laws but same democratic systems alone are faulty. This is cherry picking the conclusion/data you want.

It might help to analyze other key factors contributing to Japan's higher suicide rate:

Japan suffers some of the most natural disasters of any country in the world. It has the most and worst earthquakes. It is one of 3 Asian countries (China, Indonesia) on the Pacific Ridge to experience most of the world's seismic activity.

Natural disasters displaces people; they lose homes and family members, diseases can incur -- all this typically throw people into poverty and long-term depression, as well as financial ruin and unemployment. Do these tragedies increase the rate of suicide? You'd think?

Don't forget Japan's destructive tsunami of 2011 which had a 9.0 magnitude; leaving more than 225,000 people died, a half a million were injured, and millions were left homeless.

I don't think it's quite that simple. While I don't view guns as the driving factor in suicide, they are something that can be picked up impulsively in a crisis moment with deadly results. If China has more suicides than America percentagewise, you also have to figure in standard of living, happiness of its inhabitants in general, accessibility of mental healthcare, and cultural factors. For example way more women than men commit suicide in China, while it's not so in the U.S., though we are currently seeing a trend of more middle-aged women committing suicide in the U.S. Most often cited as motivation for suicide in China: working conditions. It would be hard for me to imagine that if there were as many guns in China as in the U.S., suicide rates would not increase. Just makes it easier to off yourself. China has a history of "honored" suicide techniques that would best be kept in its past.

"Analyzing the availability of guns as a suicide risk factor in the USA vs. Japan"

Natural disasters still wreck the most havoc on people than any planned or unplanned suicide/honor killings. Although the human cost of wars and genocide may rank higher than natural disasters, especially in the long-run.

C.S. Lewis said, "What you see and what you hear depends a great deal on where you are standing. It also depends on what sort of person you are.” Attributing causation to guns, earthquakes, movies or changing hair styles side steps the issue. People commit suicide because they have lost even if momentarily the will to live in whatever circumstances they find themselves.
It is easier and assuages our collective apprehension and feelings of helplessness to point to external things in an effort to feel like we can or have done something. It is far more difficult to take on the actual problem and attempt to provide comprehensive mental health intervention and treatment that would engage and maintain even a McCready.
The answer to suicide is not in managing the moment but in all the days, months and even years that precede.
Causality is probably the least understood aspect of science. It is both rather simple and at the same time most elusive. After its all said and done, people who commit suicide kill themselves.

Right. See also:
* the Australian gun buyback
* the Israeli army
* suicide barriers on bridges
* state-by-state comparisons of gun control measures
* reducing toxicity of popular suicide attempt pharmaceuticals

Intervention studies clearly show that reducing access to the primary means reduces all suicides, not just those done by a particular method.

You may still argue that it's not worth the cost, but it seems pretty clear that reducing access to firearms reduces the suicide rate.

What of Japan vs US? It doesn't establish the intended point. All it shows is that there are also other factors that drive suicide rates. I'd expect that if Japan suddenly had US level access to firearms, their suicide rate would be higher still.

I appreciate the NYT article and the emphasis on the "How" versus the "Why" in approaching suicide.
Clearly when a specific single focus of a problem can be identified and can be addressed it should be.
The coal gas story was interesting, however it was admittedly coincidental in its effect on suicide. If the conversion to a safer gas was not possible I doubt England would have gone back to open fireplaces and wood as a policy to reduce suicide.
The Ellington Bridge story is similar. Raising the height of the side walls to match the nearby Taft Bridge or putting some other barrier was appropriate and a similar measure is long over due at the Golden Gate Bridge in San Francisco where I believe a person jumps about every other week.
However, taking down all bridges as public policy to reduce suicide is not a consideration.
If registering, checking, controlling or banning is so effective why do we have such a drug problem in the country and why would anyone give thought to legalizing drugs?
My initial post was not intended to be a defense of guns or the Second Amendment, but an appeal to not allow those for which gun control is their issue to hijack the suicide discussion as an opportunity and allow the true need of mental health reform to be pushed back because it is more difficult.
The Community Mental Health Act of 1963 needs to be reviewed critically and its shortcomings and failures to be acknowledged and addressed.
"Background checks" for gun purchases are more a fantasy than a reality in actually achieving anything. It assumes that background information actually exists for people in a meaningful way and that it is accessible. It ignores personal privacy issues around healthcare information and especially healthcare related to mental illness or substance addiction. It ignores the effect on further inhibiting rather than encouraging people to seek help when they need it and it further fuels stigmatization.
It assumes mental health professionals can do more than they currently do, either for lack of training,
experience, access to supportive resources or staffing.
The recent gun legislation is admitted by its supporters to not have impacted any of the recent violent events in our country and I dare say it would not impact suicide rates either.
I am asking for intellectual honesty. There are those who support the right to bare arms and those who oppose it. There are those who would have everyone carry concealed weapons and those who would reserve weapons only for the power of the State. So be it.
I would only ask that mental illness not be continuously used as a catalyst for political agendas and continue to go unaddressed in meaningful ways. Mental illness is rarely more than one degree of freedom away from all of us.

Gun access is important but it isn't the sole predictor of suicide rates internationally. Boiled down, two things are important: the proportion of people who try to kill themselves in a given country, and the lethality of the methods they use. It's true that "means matter," but guns aren't the only means that matter. Here in the U.S., suicide attempters tend to swallow pills and most don't die. It's hard to kill yourself with pills unless you know which ones. But in a place like Sri Lanka, attempters tend to use pesticides,and the suicide rate is much higher because pesticides are more lethal than pills on average. Overall, the U.S. has a relatively moderate suicide rate. But where gun ownership is high in the US., the suicide rate is high. It isn't thaat gun owners are more likely to be suicidal. It's that they're more likely to die in a suicide attempt because they're more likely to use a gun.

If you're treating a patient who has guns at home and is at risk of suicide, ask them to consider storing the guns away from home until they're feeling better or to lock the guns and store the keys away from home. People on all side of the gun rights issue can agree on safety steps like these. It's not a panacea, but it makes things a little safer while you try to address the patient's underlying issues.